Rectal artesunate for severe malaria, implementation research, Zambia.

Area of Science:

• Global Health
• Infectious Diseases
• Public Health Interventions

Background:

• Severe malaria remains a critical threat to young children in many regions.
• Pilot projects demonstrated the potential of community-level rectal artesunate administration.
• Scaling up successful interventions requires careful planning and community engagement.

Purpose of the Study:

• To evaluate the scalability of community-based rectal artesunate administration for severe malaria in Zambia.
• To assess the impact of a large-scale intervention on severe malaria case fatality rates.
• To determine the effectiveness of integrated support systems in reducing malaria-related deaths.

Main Methods:

• A multi-district intervention (2018-2021) trained community health volunteers to administer pre-referral rectal artesunate.
• Support systems including emergency transport and savings were established to facilitate timely referrals.
• Health workers were trained for severe malaria case management, and data were collected via surveys and health information systems.

Main Results:

• Reported deaths from severe malaria significantly decreased in both demonstration and scale-up districts.
• In demonstration districts, deaths reduced from 3.1% to 0.5%.
• In scale-up districts, deaths reduced from 6.2% to 0.6%, despite challenges like the COVID-19 pandemic.

Conclusions:

• Pre-referral rectal artesunate by community health volunteers is an effective intervention for severe malaria in young children.
• The intervention's success was enhanced by integrated community support systems.
• Findings support the wider expansion of this strategy in Zambia and other malaria-endemic areas.